12 Oregon insurers fail to pay full cost of eligible reproductive services, audits find – Oregon Capital Chronicle

Oregonians are guaranteed free reproductive health care, including abortion, under a law that took full effect in 2019. But at least a dozen insurance companies billed consumers anyway, state officials said Wednesday.

The Department of Consumer and Business Services has issued reports on violations by 12 health insurers covering nearly one million Oregonians. An audit goes into the information presented first report released last summer.

The audit found that the companies, which cover people through individual and group markets, failed obey the law, the Reproductive Health Equity Act. They charge copays, apply payments to deductibles that must be paid before insurance begins or fail to pay authorized benefits that should be free.

In some cases, insurers completely deny their claims or fail to resolve consumer complaints, the department said in a statement.

The state found violations by Aetna Life Insurance Co., BridgeSpan Health Co., Cigna Health and Life Insurance Co., HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon, Samaritan Health Plans, UnitedHealthcare Insurance Co., and UnitedHealthcare of Oregon.

“RHEA is a very important tool in the state’s effort to remove barriers to reproductive health care,” said Andrew Stolfi, state insurance commissioner and department director, in a statement. “As with all legislation, our insurers had a responsibility to fully and timely implement each aspect of the RHEA in all of their plans. It is disappointing to see that this did not happen.”

Also Read :  Colorado Gears Up for Paid Family and Medical Leave Program

The department said it will continue to address the issue, including refunds to customers. A state task force on Reproductive Health and Access to Care, which Democratic House Speaker Dan Rayfield convened last summer to analyze how Oregon can protect access to abortion after the US Supreme Court overturned Roe v. Wade, recommended in December that the state further enforce supply orders.

The Reproductive Health Equity Act, passed by the Legislature in 2017, includes annual health visits, birth control, abortions, cancer and sexually transmitted disease screenings, breastfeeding support and other services. Does not apply to all insurance companies, however. The company’s insurance plans and Medicare, which covers 1.5 million people, are exempt. Auditors did not look at compliance among Medicaid insurers, which cover one in three Oregonians, but that insurance is free.

The suppliers billed the insurance companies but sometimes the insurance did not cover the full amount that was invoiced. That’s when consumers are charged, said Mark Peterson, a spokesman for the Department of Consumer and Business Services. In some cases, however, suppliers accept a lower price.

“We’ve heard anecdotal evidence that some suppliers are eating those costs rather than passing them on to consumers, Peterson told the Capital Chronicle.

The audit looked at claims from Jan. 1. 2019 to Dec. 31, 2020, the law was in full force for the first two years. With individual and group coverage, the 12 companies insure about 900,000 people, the data ministry said.

Also Read :  Opioid crisis cost U.S. nearly $1.5 trillion in 2020 -congressional report

All 12 insurers failed to pay all costs of all services or goods according to the law, the Ministry said. Three of them — Aetna, BridgeSpan and Regence — didn’t cover certain types of birth control pills or didn’t allow 12-month refills.

Three other insurance companies – Cigna, HealthNet, Kaiser and Samaria – failed to resolve all consumer complaints or produce documentation showing that they responded appropriately to complaints and complaints. They also failed to show that the employees who handle complaints are aware of the requirements under this law, said the Department.

Two companies – Heath Net and Moda – did not publicly respond to the findings. Others have posted an answer. Kaiser, PacificSource again UnitedHealthcare of Oregon he said they agree with the findings, and Kaiser even detailed the steps he took to comply with the law.

Cignaon the other hand, it said it “disagrees with certain factual findings in the report,” too a Samaritanwhich has confirmed the 2,000 people involved in the act, denied that it failed to keep the necessary records.

Aetna submitted a lengthy and detailed rebuttal to the findings of a a 17-page book.

“Rather than providing specific examples of claims that Aetna processed during the RHEA violation investigation, the final report instead makes general statements and draws inferences from hypothetical situations that are not supported by the data that Aetna actually submitted,” they wrote.

Also Read :  Colorado hospitals, the state tell different stories about profits

Providence said in its response that its differences with what was found were “small and limited,” and asked the department to make the requirements for inclusion under the law more clear. That sentiment was echoed by PacificSource.

“Since the passage of the Reproductive Health Equity Act in 2017, the department has not attempted to advance the standards applied to us in this inspection report,” PacificSource said.

The Regency again Bridgespanwhich is owned by Cambia Health Solutions, has asked the department to enact a law outlining the requirements of the law.

“We have applied the RHEA law in good faith and with good intentions to comply with the requirements of the law as we read it,” they said in their response letters. “Where the law was silent or ambiguous, without additional state laws and guidance, we relied on federal laws and guidance following the Affordable Care Act (ACA)’s protection requirements to protect women to fully implement the RHEA.”

The company’s list of recommendations included revising policies and procedures, training employees and monitoring complaints. The department said it will issue a guide that will help companies to comply with the law and plans to correct the situation. It said it would continue to monitor companies, require data submissions on compliance and determine fines and consumer refunds.

“We will continue to monitor each insurer until they are fully compliant with the RHEA and heal any consumer harmed by this failure,” Stolfi said.


Leave a Reply

Your email address will not be published.